Fillable Printable Business Fax Cover Sheet - Maryland
Fillable Printable Business Fax Cover Sheet - Maryland
Business Fax Cover Sheet - Maryland
Maryland
SDAT CORPORATE CHARTER DIVISION
E
xpedited Request by Fax Cover Sheet
Note: All faxed filings and requests are expedited and an expedited filing surcharge beyond the processing fee applies to each request.
See Fee Schedule at http://www.dat.state.md.us/sdatweb/
FEES.pdf for the appropriate fees or e-mail the division at sdat.charterhelp@maryland.gov or
telephone for new filings only 410-767-1340, for all other calls 410-767-1350.
_____________________________________________________________________________________________________________________
Fax all requests to 410-333-7097 Please type or print legibly, you may also fill this form out on your pc.
Name of entity:________ _________ __________ __________________________ ___________________________ _________ ___
Fax number:___________________________________________________
Phone number:________________ ___________________________ ____ __ Number of pages transmitt ed:__________________
Contact person: ___________ __________ __________ _________ __________ ________
Name and addr ess for return mail:________ __________ ___________________ __________ ___________________ __________ _
________________________________________________________________________________________________________
SERVICE REQUESTED Check all that apply.
NEW ENTITY FILING File document Return original document Note a $5.00 fee applies to this service
Certified copies of document being filed _______Number o f certified copies
Short form Certificate of Status _______Number o f certificates
RECORD REQUEST Department ID number____________________________________
Entity name______________________________________________________________________________________________
Certificate of Status for existing entity ________Number of certificates
Copies of documents previously recorded
Attach separate sheet and specify: the name and title of each document; the date of recording, if kno wn; liber and folio, if known;
the number of copies wanted for each document.
_____________________________________________________________________________________________________________________
This transaction will not be accepted without the following:
CREDIT CA RD IN FORMATIO N
O MASTERCARD O VISA (At this time we only accept Mastercard and VIsa)
Cardholder's name______________________________________________________________________________
Credit card number_____________________________________________________________________________
Billing address and zip code _______ ___________ ______________________ ______________________________
___________
__________________________________________________________________________________
Expiration date_
___________________________________ 3 Digit security code____________________________
Signature of Cardholder__________________________________________________________________________
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=====================FOR DEPARTMENTAL USE ONLY=================================
AUTH NO.______________________CLERK:__________________FEE:____________________
Revised: 10/8/14
